Pub Date : 2024-11-09DOI: 10.1016/j.carrev.2024.11.002
Muhammad Abdullah Naveed, Ahila Ali, Sivaram Neppala, Faizan Ahmed, Palak Patel, Bazil Azeem, Muhammad Omer Rehan, Rabia Iqbal, Manahil Mubeen, Ayman Fath, Timir Paul
Background: Coronary artery disease (CAD) in diabetes mellitus (DM) is a significant cause of mortality among US adults. This study investigates trends in CAD-related mortality in adults aged 25 and older with DM, focusing on geographic, gender, and racial/ethnic disparities from 1999 to 2020.
Methods: A retrospective analysis was conducted using death certificate data from the CDC WONDER database from 1999 to 2020. Age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percentage change (AAPC) were calculated per 100,000 persons, stratified by year, sex, race/ethnicity, and geographical region.
Results: CAD in DM accounted for 1,462,279 deaths among US adults aged 25+. Most deaths occurred in medical facilities (44.2 %) and at home (29.3 %). The overall AAMR for CAD in DM-related deaths decreased from 36.3 in 1999 to 31.7 in 2020, with an AAPC of -0.96 (95 % CI: -1.29 to -0.77, p < 0.000001). Men had higher AAMRs (41.6) compared to women (22.6), with a more significant decrease in women (AAPC: -2.10, p < 0.000001) than in men (AAPC: -0.34, p = 0.001200). Racial/ethnic disparities showed the highest AAMRs in American Indians/Alaska Natives (43.6), followed by Blacks (37.8), Hispanics (33.8), Whites (29.7), and Asians/Pacific Islanders (22.5). The most significant decrease was in Hispanics (AAPC: -1.64, p < 0.000001). Geographically, AAMRs ranged from 13.7 in Nevada to 51.3 in West Virginia, with the highest mortality observed in the Midwest (AAMR: 34.5). Nonmetropolitan areas exhibited higher AAMRs (35.2) than metropolitan areas (29.7), with a more pronounced decrease in metropolitan areas (AAPC: -1.22, p < 0.000001) compared to nonmetropolitan areas (AAPC: -0.03, p = 0.854629).
Conclusion: The notable increase in mortality rates associated with CAD among patients with DM from 2018 to 2020 presents a substantial concern that necessitates targeted public health interventions to ensure equitable access to cardiovascular care.
{"title":"Trends in coronary artery disease mortality among adults with diabetes: Insights from CDC WONDER (1999-2020).","authors":"Muhammad Abdullah Naveed, Ahila Ali, Sivaram Neppala, Faizan Ahmed, Palak Patel, Bazil Azeem, Muhammad Omer Rehan, Rabia Iqbal, Manahil Mubeen, Ayman Fath, Timir Paul","doi":"10.1016/j.carrev.2024.11.002","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.11.002","url":null,"abstract":"<p><strong>Background: </strong>Coronary artery disease (CAD) in diabetes mellitus (DM) is a significant cause of mortality among US adults. This study investigates trends in CAD-related mortality in adults aged 25 and older with DM, focusing on geographic, gender, and racial/ethnic disparities from 1999 to 2020.</p><p><strong>Methods: </strong>A retrospective analysis was conducted using death certificate data from the CDC WONDER database from 1999 to 2020. Age-adjusted mortality rates (AAMRs), annual percent change (APC), and average annual percentage change (AAPC) were calculated per 100,000 persons, stratified by year, sex, race/ethnicity, and geographical region.</p><p><strong>Results: </strong>CAD in DM accounted for 1,462,279 deaths among US adults aged 25+. Most deaths occurred in medical facilities (44.2 %) and at home (29.3 %). The overall AAMR for CAD in DM-related deaths decreased from 36.3 in 1999 to 31.7 in 2020, with an AAPC of -0.96 (95 % CI: -1.29 to -0.77, p < 0.000001). Men had higher AAMRs (41.6) compared to women (22.6), with a more significant decrease in women (AAPC: -2.10, p < 0.000001) than in men (AAPC: -0.34, p = 0.001200). Racial/ethnic disparities showed the highest AAMRs in American Indians/Alaska Natives (43.6), followed by Blacks (37.8), Hispanics (33.8), Whites (29.7), and Asians/Pacific Islanders (22.5). The most significant decrease was in Hispanics (AAPC: -1.64, p < 0.000001). Geographically, AAMRs ranged from 13.7 in Nevada to 51.3 in West Virginia, with the highest mortality observed in the Midwest (AAMR: 34.5). Nonmetropolitan areas exhibited higher AAMRs (35.2) than metropolitan areas (29.7), with a more pronounced decrease in metropolitan areas (AAPC: -1.22, p < 0.000001) compared to nonmetropolitan areas (AAPC: -0.03, p = 0.854629).</p><p><strong>Conclusion: </strong>The notable increase in mortality rates associated with CAD among patients with DM from 2018 to 2020 presents a substantial concern that necessitates targeted public health interventions to ensure equitable access to cardiovascular care.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630426","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-08DOI: 10.1016/j.carrev.2024.11.001
Julian Yeoh, Garry W Hamilton, Diem Dinh, Angela Brennan, Christopher M Reid, Dion Stub, Melaine Freeman, Martin Sebastian, Ernesto Oqueli, Andrew Ajani, Tim Scully, Liam Toner, Sandra Picardo, Mark Horrigan, Matias B Yudi, Omar Farouque, Siven Seevanayagam, David J Clark
Background: Complex Revascularisation in High-Risk Indicated Patients (CHIP) is emerging in Percutaneous Coronary Intervention (PCI). We document the frequency and outcomes following CHIP PCI in the Australian population, to understand risk and guide clinical decision-making. We propose a scoring system to define CHIP procedures.
Methods: Patients undergoing PCI from Melbourne Intervention Group registry between 2005 and 2018 were analysed. Patients were stratified based on the number of high-risk features defined as 1)presence of ≥3 patient factors including age > 75yo, COPD, diabetes, renal impairment (eGFR<60 mL/min/1.73 m2), PVD, and 2)LVEF<30 %, and/or 3)having one complex coronary anatomical feature such as LMCA PCI, ACC/AHA B2/C lesion PCI, presence of multi-vessel disease or CTO PCI. National Death Index linkage was performed for long-term mortality analysis. Outcomes were analysed according to 4 risk categories - low risk(score 0), intermediate risk(score 1), high-risk(score 2), and very high-risk(score 3).
Results: 20,973patients were analysed. Majority of patients underwent intermediate-risk procedures(71.7 %), with low rates of high-risk(6.6 %), and very high-risk(0.2 %). Lesion success inversely correlates with risk; low-risk(99.4 %), intermediate-risk(95.1 %), high-risk(94.3 %), very high-risk(92.5 %),p < 0.001. In-hospital and 30-day death correlates with risk; low-risk(0.0 %/0.1 %), intermediate-risk(0.3 %/0.5 %), high-risk(1.5 %/2.9 %), very high-risk(2.4 %/7.1 %),p < 0.001. Long-term mortality correlates with risk; low-risk(12.3 %), intermediate-risk(15.8 %), high-risk(49.3 %), very high-risk(76.2 %),p < 0.001. On multivariate analysis, increasing risk correlates with long-term mortality; intermediate-risk(HR1.41), high-risk(HR6.42), and very high-risk(14.05).
Conclusion: In the Australian practice, proportion of patients undergoing high and very high-risk PCI procedures are low. Despite good procedural success and in-hospital outcomes, long-term mortality is poor. Further research into appropriate patient selection, and direct comparison of CHIP PCI to those treated medically and surgically should be considered.
{"title":"Understanding long-term risk in Percutaneous Coronary Intervention (PCI) in the Australian contemporary era with a focus on defining Complex Revascularisation in High-Risk Indicated Patients (CHIP).","authors":"Julian Yeoh, Garry W Hamilton, Diem Dinh, Angela Brennan, Christopher M Reid, Dion Stub, Melaine Freeman, Martin Sebastian, Ernesto Oqueli, Andrew Ajani, Tim Scully, Liam Toner, Sandra Picardo, Mark Horrigan, Matias B Yudi, Omar Farouque, Siven Seevanayagam, David J Clark","doi":"10.1016/j.carrev.2024.11.001","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.11.001","url":null,"abstract":"<p><strong>Background: </strong>Complex Revascularisation in High-Risk Indicated Patients (CHIP) is emerging in Percutaneous Coronary Intervention (PCI). We document the frequency and outcomes following CHIP PCI in the Australian population, to understand risk and guide clinical decision-making. We propose a scoring system to define CHIP procedures.</p><p><strong>Methods: </strong>Patients undergoing PCI from Melbourne Intervention Group registry between 2005 and 2018 were analysed. Patients were stratified based on the number of high-risk features defined as 1)presence of ≥3 patient factors including age > 75yo, COPD, diabetes, renal impairment (eGFR<60 mL/min/1.73 m2), PVD, and 2)LVEF<30 %, and/or 3)having one complex coronary anatomical feature such as LMCA PCI, ACC/AHA B2/C lesion PCI, presence of multi-vessel disease or CTO PCI. National Death Index linkage was performed for long-term mortality analysis. Outcomes were analysed according to 4 risk categories - low risk(score 0), intermediate risk(score 1), high-risk(score 2), and very high-risk(score 3).</p><p><strong>Results: </strong>20,973patients were analysed. Majority of patients underwent intermediate-risk procedures(71.7 %), with low rates of high-risk(6.6 %), and very high-risk(0.2 %). Lesion success inversely correlates with risk; low-risk(99.4 %), intermediate-risk(95.1 %), high-risk(94.3 %), very high-risk(92.5 %),p < 0.001. In-hospital and 30-day death correlates with risk; low-risk(0.0 %/0.1 %), intermediate-risk(0.3 %/0.5 %), high-risk(1.5 %/2.9 %), very high-risk(2.4 %/7.1 %),p < 0.001. Long-term mortality correlates with risk; low-risk(12.3 %), intermediate-risk(15.8 %), high-risk(49.3 %), very high-risk(76.2 %),p < 0.001. On multivariate analysis, increasing risk correlates with long-term mortality; intermediate-risk(HR1.41), high-risk(HR6.42), and very high-risk(14.05).</p><p><strong>Conclusion: </strong>In the Australian practice, proportion of patients undergoing high and very high-risk PCI procedures are low. Despite good procedural success and in-hospital outcomes, long-term mortality is poor. Further research into appropriate patient selection, and direct comparison of CHIP PCI to those treated medically and surgically should be considered.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142630432","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-07DOI: 10.1016/j.carrev.2024.11.003
Elisabetta Moscarella, Gianluca Campo, Massimo Leoncini, Salvatore Geraci, Elisa Nicolini, Bernardo Cortese, Bruno Loi, Vincenzo Guiducci, Salvatore Saccà, Attilio Varricchio, Paolo Vicinelli, Gianfranco De Candia, Davide Personeni, Paolo Calabrò, Salvatore Brugaletta, Azeem Latib, Maurizio Tespili, Alfonso Ielasi
Background: Data on Absorb bioresorbable vascular scaffold (BVS) use in patients presenting with ST-segment elevation myocardial infarction (STEMI) are limited. Furthermore, Absorb studies including STEMI patients lacked a prespecified implantation technique to optimize BVS deployment. This study examines the 5-year outcomes of BVS in STEMI patients using an optimized implantation strategy and the impact of prolonged dual antiplatelet therapy (DAPT).
Methods: The BVS STEMI STRATEGY-IT study is a prospective, non-randomized, single-arm multicenter trial (NCT02601781). It involved 505 STEMI patients undergoing primary percutaneous coronary intervention with a predefined BVS implantation protocol. Key endpoints were a 5-year device-oriented composite endpoint (DOCE) of cardiac death, target-vessel myocardial infarction (TV-MI), and ischemia-driven target lesion revascularization (ID-TLR). The study also compared outcomes based on DAPT duration (36 months vs. shorter).
Results: 502 (99.4 %) patients completed the 5-year follow-up. DOCE rate was 2.4 %. ID-TLR, TV-MI, and cardiac death rates were 1.6 %, 0.8 %, and 0.6 %, respectively. No DOCE occurred between three and five years. Scaffold thrombosis (ScT) was 1 %, all occurring within 24 months. Longer-term DAPT significantly reduced DOCE (1.3 % vs. 4.3 %; HR: 0.29; 95 % CI: 0.1-0.9; p = 0.03) driven by a lower rate of TV-MI (0 % vs. 2.2 %; p = 0.018) compared to shorter-term DAPT, as well as ScT (0 % vs 2.7 %, p = 0.007).
Conclusions: This study shows favorable 5-year outcomes for BVS in selected STEMI patients with an optimized implantation strategy. Prolonged DAPT further improved outcomes, emphasizing its role in reducing adverse events during scaffold resorption. Further research is needed to assess newer-generation bioresorbable devices.
{"title":"Five-year clinical outcomes of STEMI patients treated with a pre-specified bioresorbable vascular scaffold implantation technique: Final results of the BVS STEMI STRATEGY-IT.","authors":"Elisabetta Moscarella, Gianluca Campo, Massimo Leoncini, Salvatore Geraci, Elisa Nicolini, Bernardo Cortese, Bruno Loi, Vincenzo Guiducci, Salvatore Saccà, Attilio Varricchio, Paolo Vicinelli, Gianfranco De Candia, Davide Personeni, Paolo Calabrò, Salvatore Brugaletta, Azeem Latib, Maurizio Tespili, Alfonso Ielasi","doi":"10.1016/j.carrev.2024.11.003","DOIUrl":"https://doi.org/10.1016/j.carrev.2024.11.003","url":null,"abstract":"<p><strong>Background: </strong>Data on Absorb bioresorbable vascular scaffold (BVS) use in patients presenting with ST-segment elevation myocardial infarction (STEMI) are limited. Furthermore, Absorb studies including STEMI patients lacked a prespecified implantation technique to optimize BVS deployment. This study examines the 5-year outcomes of BVS in STEMI patients using an optimized implantation strategy and the impact of prolonged dual antiplatelet therapy (DAPT).</p><p><strong>Methods: </strong>The BVS STEMI STRATEGY-IT study is a prospective, non-randomized, single-arm multicenter trial (NCT02601781). It involved 505 STEMI patients undergoing primary percutaneous coronary intervention with a predefined BVS implantation protocol. Key endpoints were a 5-year device-oriented composite endpoint (DOCE) of cardiac death, target-vessel myocardial infarction (TV-MI), and ischemia-driven target lesion revascularization (ID-TLR). The study also compared outcomes based on DAPT duration (36 months vs. shorter).</p><p><strong>Results: </strong>502 (99.4 %) patients completed the 5-year follow-up. DOCE rate was 2.4 %. ID-TLR, TV-MI, and cardiac death rates were 1.6 %, 0.8 %, and 0.6 %, respectively. No DOCE occurred between three and five years. Scaffold thrombosis (ScT) was 1 %, all occurring within 24 months. Longer-term DAPT significantly reduced DOCE (1.3 % vs. 4.3 %; HR: 0.29; 95 % CI: 0.1-0.9; p = 0.03) driven by a lower rate of TV-MI (0 % vs. 2.2 %; p = 0.018) compared to shorter-term DAPT, as well as ScT (0 % vs 2.7 %, p = 0.007).</p><p><strong>Conclusions: </strong>This study shows favorable 5-year outcomes for BVS in selected STEMI patients with an optimized implantation strategy. Prolonged DAPT further improved outcomes, emphasizing its role in reducing adverse events during scaffold resorption. Further research is needed to assess newer-generation bioresorbable devices.</p>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":" ","pages":""},"PeriodicalIF":1.6,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142639071","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.carrev.2024.04.008
Cyrus Munguti , Paul M. Ndunda , Abdullah Abukar , Mohammed Abdel Jawad , Mohinder R. Vindhyal , Zaher Fanari
Background
In the 2021 Transcatheter Valve Therapy (TVT) registry, 8.9 % of patients underwent TAVR via access sites other than the femoral artery. Transthoracic approaches may be contraindicated in some patients and may be associated with poorer outcomes. Therefore other alternative access routes are increasingly being performed. We conducted a systematic review of the literature on transcarotid transcatheter aortic valve replacement (TC-TAVR) and meta-analysis comparing outcomes of TC-TAVR and other access routes.
Methods
We comprehensively searched for controlled randomized and non-randomized studies from 4 online databases. We presented data using risk ratios (95 % confidence intervals) and measured heterogeneity using Higgins' I2.
Results
Sixteen observational studies on transcarotid TAVR were included in the analysis; 4 studies compared TC-TAVR vs TF-TAVR. The mean age and STS score for patients undergoing TC-TAVR were 80 years and 7.6 respectively. For TF-TAVR patients, mean age and STS score were 81.2 years and 6.5 respectively. There was no difference between patients undergoing TC-TAVR and TF-TAVR in the following 30-day outcomes: MACE [8.4 % vs 6.7 %; OR 1.32 (95 % CI 0.71–2.46 p = 0.38) I2 = 0 %], mortality [5.6 % vs 4.0 %; OR 0.42 (95 % CI 0.60–3.37, P = 0.42) I2 = 0 %] and stroke [0.7 % vs 2.3 %; OR 0.49 (95 % CI 0.09–2.56, P = 0.40) I2 = 0 %]. There was no difference in 30-day major vascular complications [0.7 % vs 3 %; OR 0.55 (95 % CI 0.06–5.29, P = 0.61) I2 = 39 %], major bleeding [0.7 % vs 3.8 %; OR 0.39 (95 % CI 0.09–1.67, P = 0.21) I2 = 0 %], and moderate or severe aortic valve regurgitation [8.6 % vs 9.9 %; OR 0.89 (95 % CI 0.48–1.65, P = 0.72) I2 = 0 %].
Conclusion
There are no significant differences in mortality, stroke MACE and major or life-threatening bleeding or vascular complications when TC-TAVR is compared to TF-TAVR approaches.
背景：在2021年经导管瓣膜治疗（TVT）登记中，8.9%的患者通过股动脉以外的入路接受了TAVR。经胸入路可能是某些患者的禁忌症，而且可能与较差的治疗效果有关。因此，越来越多的患者选择其他途径进行治疗。我们对经颈动脉经导管主动脉瓣置换术（TC-TAVR）的文献进行了系统性回顾，并对TC-TAVR和其他入路的疗效进行了荟萃分析：我们从 4 个在线数据库中全面检索了对照随机和非随机研究。我们使用风险比（95% 置信区间）来展示数据，并使用 Higgins'I2 来衡量异质性：16项关于经颈动脉TAVR的观察性研究被纳入分析；4项研究比较了TC-TAVR与TF-TAVR。接受TC-TAVR的患者的平均年龄和STS评分分别为80岁和7.6分。TF-TAVR患者的平均年龄和STS评分分别为81.2岁和6.5分。接受TC-TAVR和TF-TAVR的患者在以下30天结果方面没有差异：MACE [8.4 % vs 6.7 %; OR 1.32 (95 % CI 0.71-2.46 P = 0.38) I2 = 0 %]、死亡率[5.6 % vs 4.0 %; OR 0.42 (95 % CI 0.60-3.37, P = 0.42) I2 = 0 %]和中风[0.7 % vs 2.3 %; OR 0.49 (95 % CI 0.09-2.56, P = 0.40) I2 = 0 %]。30 天主要血管并发症[0.7 % vs 3 %; OR 0.55 (95 % CI 0.06-5.29, P = 0.61) I2 = 39 %]、大出血[0.7 % vs 3.8 %; OR 0.39 (95 % CI 0.09-1.67, P = 0.21) I2 = 0 %]、中度或重度主动脉瓣反流[8.6 % vs 9.9 %; OR 0.89 (95 % CI 0.48-1.65, P = 0.72) I2 = 0 %]：结论：TC-TAVR与TF-TAVR相比，在死亡率、中风MACE、大出血或危及生命的出血或血管并发症方面没有明显差异。
{"title":"Transcarotid versus transfemoral transcatheter aortic valve replacement: A systematic review and meta-analysis","authors":"Cyrus Munguti , Paul M. Ndunda , Abdullah Abukar , Mohammed Abdel Jawad , Mohinder R. Vindhyal , Zaher Fanari","doi":"10.1016/j.carrev.2024.04.008","DOIUrl":"10.1016/j.carrev.2024.04.008","url":null,"abstract":"<div><h3>Background</h3><div>In the 2021 Transcatheter Valve Therapy (TVT) registry, 8.9 % of patients underwent TAVR via access sites other than the femoral artery. Transthoracic approaches may be contraindicated in some patients and may be associated with poorer outcomes. Therefore other alternative access routes are increasingly being performed. We conducted a systematic review of the literature on transcarotid transcatheter aortic valve replacement (TC-TAVR) and meta-analysis comparing outcomes of TC-TAVR and other access routes.</div></div><div><h3>Methods</h3><div>We comprehensively searched for controlled randomized and non-randomized studies from 4 online databases. We presented data using risk ratios (95 % confidence intervals) and measured heterogeneity using Higgins' I<sup>2</sup>.</div></div><div><h3>Results</h3><div>Sixteen observational studies on transcarotid TAVR were included in the analysis; 4 studies compared TC-TAVR vs TF-TAVR. The mean age and STS score for patients undergoing TC-TAVR were 80 years and 7.6 respectively. For TF-TAVR patients, mean age and STS score were 81.2 years and 6.5 respectively. There was no difference between patients undergoing TC-TAVR and TF-TAVR in the following 30-day outcomes: MACE [8.4 % vs 6.7 %; OR 1.32 (95 % CI 0.71–2.46 <em>p</em> = 0.38) I<sup>2</sup> = 0 %], mortality [5.6 % vs 4.0 %; OR 0.42 (95 % CI 0.60–3.37, <em>P</em> = 0.42) I<sup>2</sup> = 0 %] and stroke [0.7 % vs 2.3 %; OR 0.49 (95 % CI 0.09–2.56, <em>P</em> = 0.40) I<sup>2</sup> = 0 %]. There was no difference in 30-day major vascular complications [0.7 % vs 3 %; OR 0.55 (95 % CI 0.06–5.29, <em>P</em> = 0.61) I<sup>2</sup> = 39 %], major bleeding [0.7 % vs 3.8 %; OR 0.39 (95 % CI 0.09–1.67, <em>P</em> = 0.21) I<sup>2</sup> = 0 %], and moderate or severe aortic valve regurgitation [8.6 % vs 9.9 %; OR 0.89 (95 % CI 0.48–1.65, <em>P</em> = 0.72) I<sup>2</sup> = 0 %].</div></div><div><h3>Conclusion</h3><div>There are no significant differences in mortality, stroke MACE and major or life-threatening bleeding or vascular complications when TC-TAVR is compared to TF-TAVR approaches.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"68 ","pages":"Pages 92-97"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140870081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.carrev.2024.05.003
Yoshiyuki Yamashita , Serge Sicouri , Massimo Baudo , Aleksander Dokollari , Roberto Rodriguez , Eric M. Gnall , Paul M. Coady , Harish Jarrett , Sandra V. Abramson , Katie M. Hawthorne , Scott M. Goldman , William A. Gray , Basel Ramlawi
Background/purpose
To evaluate the impact of coronary artery disease (CAD), percutaneous coronary intervention (PCI), and coronary lesion complexity on outcomes of transcatheter aortic valve replacement (TAVR) for aortic stenosis.
Methods/materials
This retrospective study included 1042 patients divided into two groups by the presence or absence of CAD (SYNTAX score 0, no history of revascularization). Propensity score matching was used to compare the two groups. The effect of PCI, SYNTAX score, and residual SYNTAX score was also analyzed.
Results
The median age of the cohort was 82 years, and 641 patients had CAD. After propensity score matching, 346 pairs were analyzed. During 5 years of follow-up (median: 25, range 0–72 months), the rate of coronary intervention was significantly higher in CAD patients (p = 0.018). However, all-cause mortality, composite of all-cause mortality, stroke, and coronary intervention, and overt bleeding defined by VARC-3 were comparable. After stratification, in patients with creatinine ≥1.5 mg/dl, CAD was associated with a worse composite outcome (p = 0.016). Neither PCI nor SYNTAX score was associated with all-cause mortality in CAD patients. Similarly, residual SYNTAX score showed no association with mortality in patients undergoing PCI (all p values >0.7). PCI did not reach a significant difference in overt bleeding in CAD patients (adjusted p = 0.06).
Conclusions
Despite a higher incidence of coronary interventions, major clinical outcomes were similar between patients with and without CAD after TAVR. In patients with chronic kidney disease, CAD may be associated with an adverse composite outcome. Neither PCI nor SYNTAX/residual SYNTAX score influenced all-cause mortality.
{"title":"Impact of coronary artery disease and revascularization on outcomes of transcatheter aortic valve replacement for severe aortic stenosis","authors":"Yoshiyuki Yamashita , Serge Sicouri , Massimo Baudo , Aleksander Dokollari , Roberto Rodriguez , Eric M. Gnall , Paul M. Coady , Harish Jarrett , Sandra V. Abramson , Katie M. Hawthorne , Scott M. Goldman , William A. Gray , Basel Ramlawi","doi":"10.1016/j.carrev.2024.05.003","DOIUrl":"10.1016/j.carrev.2024.05.003","url":null,"abstract":"<div><h3>Background/purpose</h3><div><span>To evaluate the impact of coronary artery disease (CAD), percutaneous coronary intervention (PCI), and coronary lesion complexity on outcomes of </span>transcatheter aortic valve replacement<span> (TAVR) for aortic stenosis.</span></div></div><div><h3>Methods/materials</h3><div><span><span>This retrospective study included 1042 patients divided into two groups by the presence or absence of CAD (SYNTAX score 0, no history of revascularization). </span>Propensity score matching was used to compare the two groups. The effect of PCI, </span>SYNTAX score, and residual SYNTAX score was also analyzed.</div></div><div><h3>Results</h3><div>The median age of the cohort was 82 years, and 641 patients had CAD. After propensity score matching, 346 pairs were analyzed. During 5 years of follow-up (median: 25, range 0–72 months), the rate of coronary intervention was significantly higher in CAD patients (<em>p</em><span> = 0.018). However, all-cause mortality, composite of all-cause mortality, stroke, and coronary intervention, and overt bleeding defined by VARC-3 were comparable. After stratification, in patients with creatinine ≥1.5 mg/dl, CAD was associated with a worse composite outcome (</span><em>p</em> = 0.016). Neither PCI nor SYNTAX score was associated with all-cause mortality in CAD patients. Similarly, residual SYNTAX score showed no association with mortality in patients undergoing PCI (all <em>p</em> values >0.7). PCI did not reach a significant difference in overt bleeding in CAD patients (adjusted <em>p</em> = 0.06).</div></div><div><h3>Conclusions</h3><div>Despite a higher incidence of coronary interventions, major clinical outcomes were similar between patients with and without CAD after TAVR. In patients with chronic kidney disease, CAD may be associated with an adverse composite outcome. Neither PCI nor SYNTAX/residual SYNTAX score influenced all-cause mortality.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"68 ","pages":"Pages 8-14"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140892033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.carrev.2024.05.002
Itamar Loewenstein , Ariel Finkelstein , Shmuel Banai , Amir Halkin , Maayan Konigstein , Jeremy Ben-Shoshan , Yaron Arbel , Israel Barbash , Amit Segev , Planner David , Gabby Elbaz-Greener , Hana Assa-Vaknin , Ran Kornowski , Danny Dvir , Elad Asher , Arie Steinvil
Background
The ACURATE neo2 transcatheter aortic valve was developed to improve paravalvular leak (PVL) rates while maintaining low rates of conduction disturbances and permanent pacemaker implantation (PPMI) seen with its predecessor. We aimed to compare conduction disturbances rates of transcatheter aortic valve replacement (TAVR) using ACURATE Neo2 with other commonly used valves.
Methods
A retrospective analysis of the Israeli TAVR registry between the years 2014–2023 was performed to compare conduction disturbances and PVL rates, and procedural outcomes, among patients treated with ACURATE neo2, Edwards Sapien 3 (S3), and Evolut PRO valves. Propensity score matching was performed to compare groups with similar characteristics.
Results
Following exclusion of patients with non-femoral access, unknown valve type, older-generation valves, and less commonly used valves or (n = 4387), our analysis included 3208 patients undergoing TAVR using ACURATE neo2, Edwards S3, and Evolut PRO valves. Propensity matched groups comprised 169 patients each. Rates of any conduction disturbances [left bundle branch block (LBBB), atrioventricular block, or PPMI] were lower in the ACURATE neo2 group compared to both other valves [15.8 %, S3–37.5 % (p < 0.001), Evolut PRO-27.5 % (p = 0.02)] as were LBBB rates [9.0 %, S3–31.3 % (p < 0.001); Evolut PRO-20.1 % (p = 0.01). Atrioventricular block and PPMI rates were lower without statistical significance, as were rates of above-moderate PVL.
Conclusions
In this analysis, TAVR using ACURATE neo2 was associated with a lower composite rate of conduction disturbances in comparison to the Evolut PRO and Edwards S3 valves, mainly due to lower left bundle branch block rates, with non-significantly lower rates of PPMI and PVL.
{"title":"Conduction disorders following transcatheter aortic valve replacement using acurate Neo2 transcatheter heart valve: A propensity matched analysis","authors":"Itamar Loewenstein , Ariel Finkelstein , Shmuel Banai , Amir Halkin , Maayan Konigstein , Jeremy Ben-Shoshan , Yaron Arbel , Israel Barbash , Amit Segev , Planner David , Gabby Elbaz-Greener , Hana Assa-Vaknin , Ran Kornowski , Danny Dvir , Elad Asher , Arie Steinvil","doi":"10.1016/j.carrev.2024.05.002","DOIUrl":"10.1016/j.carrev.2024.05.002","url":null,"abstract":"<div><h3>Background</h3><div>The ACURATE neo2 transcatheter aortic valve<span><span><span> was developed to improve paravalvular leak (PVL) rates while maintaining low rates of </span>conduction disturbances<span> and permanent pacemaker implantation (PPMI) seen with its predecessor. We aimed to compare conduction disturbances rates of </span></span>transcatheter aortic valve replacement (TAVR) using ACURATE Neo2 with other commonly used valves.</span></div></div><div><h3>Methods</h3><div><span>A retrospective analysis of the Israeli TAVR registry between the years 2014–2023 was performed to compare conduction disturbances and PVL rates, and procedural outcomes, among patients treated with ACURATE neo2, Edwards Sapien 3 (S3), and Evolut PRO valves. </span>Propensity score matching was performed to compare groups with similar characteristics.</div></div><div><h3>Results</h3><div>Following exclusion of patients with non-femoral access, unknown valve type, older-generation valves, and less commonly used valves or (<em>n</em><span> = 4387), our analysis included 3208 patients undergoing TAVR using ACURATE neo2, Edwards S3, and Evolut PRO valves. Propensity matched groups comprised 169 patients each. Rates of any conduction disturbances [left bundle branch block (LBBB), atrioventricular block, or PPMI] were lower in the ACURATE neo2 group compared to both other valves [15.8 %, S3–37.5 % (</span><em>p</em> < 0.001), Evolut PRO-27.5 % (<em>p</em> = 0.02)] as were LBBB rates [9.0 %, S3–31.3 % (p < 0.001); Evolut PRO-20.1 % (<em>p</em> = 0.01). Atrioventricular block and PPMI rates were lower without statistical significance, as were rates of above-moderate PVL.</div></div><div><h3>Conclusions</h3><div>In this analysis, TAVR using ACURATE neo2 was associated with a lower composite rate of conduction disturbances in comparison to the Evolut PRO and Edwards S3 valves, mainly due to lower left bundle branch block rates, with non-significantly lower rates of PPMI and PVL.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"68 ","pages":"Pages 17-22"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140891883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.carrev.2024.10.001
Spencer B. King III
{"title":"A question about what coronary angiography teaches about occlusion and thrombosis in STEMI","authors":"Spencer B. King III","doi":"10.1016/j.carrev.2024.10.001","DOIUrl":"10.1016/j.carrev.2024.10.001","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"68 ","pages":"Pages 104-105"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142510417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.carrev.2024.04.011
Andrei D. Margulescu , Dewi E. Thomas , Magid Awadalla , Parin Shah , Ayush Khurana , Omar Aldalati , Daniel R. Obaid , Alexander J. Chase , David Smith
Background
The impact of new-onset left bundle branch block (N-LBBB) developing after Transcatheter Aortic Valve Replacement (TAVR) on cardiac function and mechanical dyssynchrony is not well defined.
Methods
We retrospectively screened all patients who underwent TAVR in our centre between Oct 2018 and Sept 2021 (n = 409). We identified 38 patients with N-LBBB post-operatively (of which 28 were persistent and 10 were transient), and 17 patients with chronic pre-existent LBBB (C-LBBB). We excluded patients requiring pacing post TAVR. For all groups, we retrospectively analysed stored echocardiograms at 3 time points: before TAVR (T0), early after TAVR (T1, 1.2 ± 1.1 days), and late follow-up (T2, 1.5 ± 0.8 years), comparing LV mass and volumes, indices of LV function (LV ejection fraction, LVEF; global longitudinal strain, GLS), and mechanical dyssynchrony indices (systolic stretch index, severity of septal flash).
Results
At baseline (T0), C-LBBB had worse cardiac function, and larger LV volumes and LV mass, compared with patients with N-LBBB. At T1, N-LBBB resulted in mild dyssynchrony and decreased LVEF and GLS. Dyssynchrony progressed at T2 in persistent N-LBBB but not C-LBBB. In both groups however, LVEF remained stable at T2, although individual response was variable. Patients with better LVEF at baseline demonstrated a higher proportion of developing LBBB-induced LV dysfunction at T2. Lack of improvement of LVEF immediately after TAVR predicted deteriorating LVEF at T2. In transient LBBB, cardiac function and most dyssynchrony indices returned to baseline.
Conclusions
N-LBBB after TAVR results in an immediate reduction of cardiac function, in spite of only mild dyssynchrony. When LBBB persists, patients with better cardiac function before TAVR are more likely to have LBBB-induced LV dysfunction after TAVR.
{"title":"Prevalence and progression of LV dysfunction and dyssynchrony in patients with new-onset LBBB post TAVR","authors":"Andrei D. Margulescu , Dewi E. Thomas , Magid Awadalla , Parin Shah , Ayush Khurana , Omar Aldalati , Daniel R. Obaid , Alexander J. Chase , David Smith","doi":"10.1016/j.carrev.2024.04.011","DOIUrl":"10.1016/j.carrev.2024.04.011","url":null,"abstract":"<div><h3>Background</h3><div><span>The impact of new-onset left bundle branch block (N-LBBB) developing after </span>Transcatheter Aortic Valve Replacement (TAVR) on cardiac function and mechanical dyssynchrony is not well defined.</div></div><div><h3>Methods</h3><div>We retrospectively screened all patients who underwent TAVR in our centre between Oct 2018 and Sept 2021 (<em>n</em><span> = 409). We identified 38 patients with N-LBBB post-operatively (of which 28 were persistent and 10 were transient), and 17 patients with chronic pre-existent LBBB (C-LBBB). We excluded patients requiring pacing post TAVR. For all groups, we retrospectively analysed stored echocardiograms<span> at 3 time points: before TAVR (T0), early after TAVR (T1, 1.2 ± 1.1 days), and late follow-up (T2, 1.5 ± 0.8 years), comparing LV mass and volumes, indices of LV function (LV ejection fraction, LVEF; global longitudinal strain, GLS), and mechanical dyssynchrony indices (systolic stretch index, severity of septal flash).</span></span></div></div><div><h3>Results</h3><div>At baseline (T0), C-LBBB had worse cardiac function, and larger LV volumes and LV mass, compared with patients with N-LBBB. At T1, N-LBBB resulted in mild dyssynchrony and decreased LVEF and GLS. Dyssynchrony progressed at T2 in persistent N-LBBB but not C-LBBB. In both groups however, LVEF remained stable at T2, although individual response was variable. Patients with better LVEF at baseline demonstrated a higher proportion of developing LBBB-induced LV dysfunction at T2. Lack of improvement of LVEF immediately after TAVR predicted deteriorating LVEF at T2. In transient LBBB, cardiac function and most dyssynchrony indices returned to baseline.</div></div><div><h3>Conclusions</h3><div>N-LBBB after TAVR results in an immediate reduction of cardiac function, in spite of only mild dyssynchrony. When LBBB persists, patients with better cardiac function before TAVR are more likely to have LBBB-induced LV dysfunction after TAVR.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"68 ","pages":"Pages 23-29"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140866743","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.carrev.2024.05.005
Pavan Reddy , Matteo Cellamare , Ilan Merdler , Cheng Zhang , Sukhdeep Bhogal , Amer I. Aladin , Itsik Ben-Dor , Lowell F. Satler , Toby Rogers , Ron Waksman
Background
High-sensitivity troponin (hsTnI) is correlated with cardiac mortality; however, studies on the relationship of markedly elevated hsTnI with in-hospital mortality after cardiac surgery are sparse. Therefore, we aimed to define this relationship in order to help guide in-hospital, acute management of post-surgical patients.
Methods
We retrospectively analyzed all cardiac surgeries completed at our institution between January 2020 and June 2022 in which a peak hsTnI was noted to be >35× upper limit of normal (ULN = 34 ng/L). The primary outcome was in-hospital death. Subgroup analysis was performed to assess differences between coronary artery bypass grafting (CABG) and other cardiac surgeries.
Results
A total of 1382 cases met inclusion criteria. The patients' mean age was 64.8 years and 68.2 % were male. Median peak hsTnI after surgery was 4202 ng/L (interquartile ratio: 2427–7654). Univariate analysis of troponin level with mortality found that for every 1000 ng/L increase in hsTnI, odds of in-hospital death increased by 3.8 % (odds ratio [OR]: 1.038; 95 % confidence interval [CI] 1.027–1.050; p < 0.0001). In a multivariate model, troponin (OR 1.02; 95 % CI 1.01–1.04; p = 0.004) maintained a significant association with in-hospital death. CABG was associated with a lower risk of in-hospital death for any given hsTnI level up to 60,000 ng/L compared to other cardiac surgeries.
Conclusion
Increasing hsTnI level is associated with increasing probability of in-hospital mortality and, therefore, serves as an additional, objective measure of risk to help guide in-hospital clinical management.
{"title":"Markedly elevated high-sensitivity troponin and in-hospital mortality after cardiac surgery","authors":"Pavan Reddy , Matteo Cellamare , Ilan Merdler , Cheng Zhang , Sukhdeep Bhogal , Amer I. Aladin , Itsik Ben-Dor , Lowell F. Satler , Toby Rogers , Ron Waksman","doi":"10.1016/j.carrev.2024.05.005","DOIUrl":"10.1016/j.carrev.2024.05.005","url":null,"abstract":"<div><h3>Background</h3><div>High-sensitivity troponin (hsTnI) is correlated with cardiac mortality; however, studies on the relationship of markedly elevated hsTnI with in-hospital mortality after cardiac surgery are sparse. Therefore, we aimed to define this relationship in order to help guide in-hospital, acute management of post-surgical patients.</div></div><div><h3>Methods</h3><div>We retrospectively analyzed all cardiac surgeries completed at our institution between January 2020 and June 2022 in which a peak hsTnI was noted to be >35× upper limit of normal (ULN = 34 ng/L). The primary outcome was in-hospital death. Subgroup analysis was performed to assess differences between coronary artery bypass grafting (CABG) and other cardiac surgeries.</div></div><div><h3>Results</h3><div><span>A total of 1382 cases met inclusion criteria. The patients' mean age was 64.8 years and 68.2 % were male. Median peak hsTnI after surgery was 4202 ng/L (interquartile ratio: 2427–7654). Univariate analysis<span> of troponin level with mortality found that for every 1000 ng/L increase in hsTnI, odds of in-hospital death increased by 3.8 % (odds ratio [OR]: 1.038; 95 % confidence interval [CI] 1.027–1.050; </span></span><em>p</em> < 0.0001). In a multivariate model, troponin <strong>(</strong>OR 1.02; 95 % CI 1.01–1.04; <em>p</em> = 0.004) maintained a significant association with in-hospital death. CABG was associated with a lower risk of in-hospital death for any given hsTnI level up to 60,000 ng/L compared to other cardiac surgeries.</div></div><div><h3>Conclusion</h3><div>Increasing hsTnI level is associated with increasing probability of in-hospital mortality and, therefore, serves as an additional, objective measure of risk to help guide in-hospital clinical management.</div></div>","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"68 ","pages":"Pages 57-61"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140892075","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-11-01DOI: 10.1016/j.carrev.2024.06.009
Keisuke Yasumura, Annapoorna S. Kini, Samin K. Sharma
{"title":"Editorial: Tackling coronary calcified nodules: “Shocking our way to success?”","authors":"Keisuke Yasumura, Annapoorna S. Kini, Samin K. Sharma","doi":"10.1016/j.carrev.2024.06.009","DOIUrl":"10.1016/j.carrev.2024.06.009","url":null,"abstract":"","PeriodicalId":47657,"journal":{"name":"Cardiovascular Revascularization Medicine","volume":"68 ","pages":"Pages 43-44"},"PeriodicalIF":1.6,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141312002","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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